5 most over-prescribed antibiotics

The repercussions of antibiotic resistance are once again underscored in a recent policy brief from Health Affairs and the Robert Wood Johnson Foundation.

To some degree, antibiotic resistance is unavoidable, but the more antibiotics are used, the more opportunities bacteria have to evolve to defeat them, according to the policy brief. The CDC estimates that up to 50% of antibiotics are unnecessary or inappropriate as prescribed-in medicine and agriculture-which has led to a slew of “superbugs.”

Related: BLOG: Time to show and tell about antibiotic stewardship programs

“For antibiotics, drug choice must be driven by clinical imperatives, not just cost,” according to policy brief reviewer Kevin Outterson, professor of law and N. Neal Pike Scholar in Health and Disability Law, Boston University. “Every US hospital will need a stewardship program, as a condition of participation in Medicare in 2017.”

“Antibiotics are misused so often because of the belief that these are benign drugs and that patient satisfaction depends upon being prescribed an antibiotic,” said Amesh Adalja, MD, an Infectious Diseases Society of America spokesperson.

Here are the 5 most over-prescribed antibiotics, according to Dr Adalja. 

1. Azithromycin

This antibiotic is often given incorrectly for viral infections such as the common cold, sinus infections, and acute bronchitis. It is an easy drug to prescribe with minimal side effects and that often tends to cause it to be misused in order to placate a patient with a viral infection who often wants an antibiotic irrespective of the fact that their illness is caused by a virus. These patients would be better served with cough suppressants and drugs such as ibuprofen or acetaminophen.

2. Amoxicillin

This antibiotic is often overprescribed for viral infections such as acute bronchitis, mild ear infections, and viral pharyngitis. These patients would be better served with cough suppressants and drugs such as ibuprofen or acetaminophen.

3. Cephalexin

This antibiotic is overprescribed for skin conditions which may not even require an antibiotic to be prescribed because they are non-infectious, will resolve on their own, or can be treated with topical antibiotics.

4. Trimethoprim-sulfamethoxazole (TMP/SMX) 

This antibiotic is overprescribed for urinary tract infections which may not be true infections as many elderly, for example, chronically have bacteria in their urine. It is also unnecessarily given for skin boils, which usually don’t require antibiotics once they’ve been adequately drained.

5. Ciprofloxacin

This antibiotic is often overprescribed for urinary tract infections which really are not urinary tract infections or when a simpler antibiotic such as TMP/SMX or nitrofurantoin would be sufficient.

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